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The prostate gland is the walnut-sized gland that makes up part of a man's reproductive system. It secretes a fluid that contributes to the semen that sperm swim in. The term prostatitis refers to inflammation of the prostate gland. Acute bacterial prostatitis is simple. It is an infection of the prostate that responds to antibiotics.

Unfortunately, chronic prostatitis is not so simple — and it’s a lot more common than acute prostatitis. It’s also more difficult to understand. Doctors tend to have trouble both diagnosing it correctly and treating it successfully. To add to the complexity, several studies have found a link between chronic prostatitis and fertility problems in men.

"Part of the confusion with chronic prostatitis and infertility is that what we call chronic prostatitis is not one but several different diseases," says Daniel Shoskes, MD, a urology specialist at the Cleveland Clinic in Ohio, "and not all types of chronic prostatitis cause infertility."

Types of Chronic Prostatitis

It is estimated that about nine percent of men ages 18 and older are diagnosed with chronic prostatitis. This diagnosis may signal one of the following conditions:

Chronic bacterial prostatitis. This is caused by bacteria that infect the prostate gland over a long period of time. It does not always respond well to antibiotics.

Chronic pelvic pain syndrome. The most common cause of chronic prostatitis and the least understood, it can cause symptoms of chronic prostatitis without any evidence of bacteria.

Asymptomatic inflammatory prostatitis. There are no symptoms, but it is diagnosed when white blood cells are found in seminal fluid during a fertility test.

"Infertility has been linked to the types of chronic prostatitis that cause white blood cells to mix with sperm. That means chronic bacterial prostatitis or asymptomatic inflammatory prostatitis, but probably not chronic pelvic pain syndrome," explains Dr. Shoskes.

How Do White Blood Cells Affect Fertility?

White blood cells are part of the body's defense system that fights infection. Studies show that when these cells, also called leukocytes, are found in prostate secretions, they decrease sperm function, sperm quality, and fertility.

Doctors don't know exactly how white blood cells have this effect on sperm, but it may have something to do with molecules produced by white blood cells called reactive oxygen species. These molecules are part of the white blood cells’ disease-fighting properties. Studies show that reactive oxygen species are elevated in semen samples from up to 40 percent of infertile men.

"Another possible but rare cause might be scar tissue that forms from a long-standing bacterial prostatitis. Scar tissue might block sperm from getting into seminal fluid," notes Shoskes. "We just don't know the exact mechanisms, but we do know that white blood cells seem to secrete substances that inhibit sperm."

Can Infertility Caused by Chronic Prostatitis Be Treated?

Shoskes says that chronic prostatitis is a rare cause of infertility, but one that may be reversible. "If chronic prostatitis is caused by bacteria, antibiotics may reverse the inflammation and the infertility. In cases where there are white blood cells without bacteria, there is some evidence that treatment with antioxidants may help," he explains.

Vitamins C, E, A, and other antioxidants may help protect sperm cells from the effects of reactive oxygen species. Antioxidants can be taken as nutritional supplements, but they are also found in many foods, especially fruits, vegetables, nuts, and grains.

Fertility is a complicated process that depends on many bodily functions working properly. Male infertility accounts for at least one-third of these cases. We are still learning about the possible links between chronic prostatitis and fertility. Further research should help unravel the mystery of chronic prostatitis and how it may be contributing to male infertility.